Treatment Services

Cerebral Palsy Center at Nemours/Alfred I. duPont Hospital for Children

Children with neuromuscular conditions such as cerebral palsy (CP) usually require the expertise of a comprehensive team of healthcare professionals from orthopedics, neurology and other specialties as needed. You'll find that at Nemours/Alfred I. duPont Hospital for Children’s Cerebral Palsy Center. Our CP care is among the very best in the world. In fact, we’re consistently ranked among the best children’s hospitals in the nation by U.S. News & World Report.

Your Child's Cerebral Palsy Treatment

At the Cerebral Palsy Center, we offer a wide range of specialists from a variety of departments — all of whom can be called in to help your child reach the best possible health, comfort and quality of life.

Advancing Children’s Care at the Swank Center for Neuro-Orthopaedics

In 2011, the Swank Center for Neuro-Orthopaedics was founded, thanks to the first of two generous donations from the Howard W. Swank, Alma K. Swank and Richard Kemper Swank Foundation of Wilmington, Del.

The first donation is helping countless children through the:

the creation of a cerebral palsy database

new equipment to fabricate orthotics for children with disabilities

professional and family education

psychological support for children with neuro-orthopedic conditions and their families

improvements to the hospital’s Gait and Motion Analysis Laboratory

The second gift helped establish a new tissue repository to support research on neuro-orthopedic conditions like cerebral palsy.

The Center helps us provide a variety of services related to serving kids with CP, including:

comprehensive care for children with CP and emotional support for their families

education and training for practitioners in their care

use of advanced technology and orthotics (devices or inserts to assist or modify your child’s movements) to improve daily living

support for research to develop new and better therapies and assistive devices

Orthopedics

Orthopedics (sometimes spelled “orthopaedics”) is the branch of medicine that treats conditions involving the musculoskeletal system. “Orthopedic” comes from Greek and means “correct or straight child.” The goal of our pediatric orthopedic specialists — who will be leading the care of your child — is to recognize and treat neuromuscular and musculoskeletal conditions as early in life as possible. We’ll help restore your child’s musculoskeletal system as much as possible to give your child maximum function and quality of life.

The Cerebral Palsy Center’s orthopedic specialists will most often see your child between the ages of 18 and 24 months, with outpatient visits taking place every six to 12 months. Throughout this care, we’ll monitor and assess your child’s motor development, and provide evaluations and prescriptions for any necessary adaptive equipment such as walkers, wheelchairs and standers. We coordinate prescriptions for these devices with assessments done in school or outpatient therapy centers — if these are not available, we’ll coordinate it through our onsite Wheelchair Clinic or Equipment Evaluation Clinic.

We also evaluate your child for orthotics (devices or inserts to assist or modify your child’s movements) and braces, confirming both fit and appropriate functional benefit. Most children need new orthotics every 12 months. For your convenience, an orthotics shop is available in the hospital.

Neurology

Neurology, also from Greek for the “study of nerves,” is a medical specialty dealing with the diagnosis and treatment of disorders of the nervous system. Neurological issues can affect your child’s cognitive functioning (ability to think, reason and make behavior choices), physical functioning (the way the body works) or both. Many children with CP have seizures and our neurologists are the primary specialists in the management of seizures. Our Nemours pediatric neurologists take a team approach that brings in a variety of specialists who work together to give your child the best possible care.

General Pediatrics

Some of our general pediatricians (who treat children with all kinds of conditions) specialize in conditions such as cerebral palsy. They work with the Cerebral Palsy Center to help you manage your child’s overall health, especially focusing on nutrition and feeding concerns. They evaluate and treat problems related to bone weakness and frequent fractures, as well as developmental milestones, learning ability and behavior concerns. They can help coordinate care with other specialists your child may need.

Rehabilitation Medicine

Pediatric rehabilitation medicine (also known as “pediatric physical medicine and rehabilitation” or “PM&R,” for short) helps improve mobility, functional skills and/or communication skills affected by disease or injury. A pediatric rehabilitation medicine physician may also be called a “pediatric physiatrist.”

Cerebral palsy can affect your child’s mobility, functional skills and/or communication skills. Rehabilitation medicine works on strengthening those skills so that your child can function as independently as possible in the home, school and community environments, and with the best quality of life.

Many children with CP have spasticity (muscle spasms or uncontrolled movements). A common treatment for this is the use of the intrathecal baclofen (a medicine that relaxes the muscles) pump. A physiatrist usually manages and refills the pumps, and helps in managing any complications related to their use.

Otolaryngology (ENT)

Your child may require the expertise of our Otolaryngology Department. This specialty is better known as “ear, nose, and throat” or “ENT,” and is devoted to the evaluation and treatment of disorders of the head and neck, hearing, and communication problems. Our ENT specialists can assist in your child’s care if they have or develop any hearing, learning, speech or sleep issues. The most common CP problems addressed by ENT are:

Enlarged tonsils or adenoids, which can cause snoring and difficulty breathing while sleeping.

Drooling — many children with CP have significant problems with drooling.

A child psychologist or child psychiatrist is a mental health expert with advanced training in helping children and teens with emotional and behavioral issues.

Children can feel overwhelmed when they’re feeling sick, especially when they’re admitted to the hospital. Your child may feel depressed or anxious about upcoming procedures or confused about treatment for a medical condition. Our behavioral health experts can provide outpatient consultation and inpatient services to your child on these and related issues.

And, to ensure that your child gets the high-quality care and support needed, our child psychology and psychiatry team will partner with other providers and agencies in your community.

Developmental Pediatrics

Developmental pediatricians have expertise in neurodevelopmental (related to the brain or central nervous system) disabilities, or in developmental and behavioral pediatrics. These physicians address child development concerns such as physical, emotional, behavioral and social development. For your child, they can especially help with any behavior management or feeding problems common in children with CP.

Comprehensive Outpatient Rehabilitation Program (CORP)

The Comprehensive Outpatient Rehabilitation Program (CORP) brings together, on an outpatient basis, any therapy services that your child may need. The program is designed for children and adolescents who don’t require the intensity of an inpatient rehabilitation program (rehab care for children who stay in the hospital), but are continuing to progress toward specific functional rehabilitation goals. You child can live at home with you while continuing the program. The CORP staff will maintain contact with your child’s clinical team throughout the duration of participation in the program.

The program offers therapeutic outpatient programming Monday through Friday. The staff reviews each child’s progress, treatment plan, therapy schedule and goals in regularly scheduled team conferences. You and your child, when appropriate, are invited to participate in these team conferences. The minimum requirement for participation in this program is two therapeutic services (physical, occupational or speech therapy). Additional supportive therapies may include psychology, academic therapy, cognitive remediation or aquatic therapy.

Special Equipment

At the Cerebral Palsy Center, we use a variety of specialized equipment for your child’s testing and treatment, which enhances our ability to provide the nation’s best cerebral palsy care. This equipment and related professional expertise, includes the lab, where we closely examine children’s walking (gait) mechanics, orthotics and braces, and our Assistive Technology Program (which can support your child with a variety of communication, learning and mobility devices, from specialized wheelchairs to computerized communication aids).

The Gait Analysis Laboratory

Cerebral palsy and other neuromuscular conditions can lead to gait abnormalities in children (gait is how a person walks). Our Gait Analysis Laboratory at Nemours/Alfred I. duPont Hospital for Children uses high-tech cameras, sensors, pressure plates and computers to capture a three-dimensional model of your child’s gait so that our Cerebral Palsy Center team can better understand your child’s needs and make the best possible recommendations for treatment.

Created in 1993, the Gait Lab was one of the first of its kind to diagnose gait problems in children. In 2014, it was one of only seven gait labs in the country to earn full accreditation from the Commission for Motion Laboratory Accreditation (CMLA). The commission awarded the lab its accreditation for “demonstrating the highest level of clinical and technical excellence in movement analysis.” The lab is the only such facility in the region based in a pediatric hospital.

The Gait Lab allows us to get detailed information about the:

movement of various joints

how the muscles contract

pressure on the limbs

the amount of energy required to make changes in your child’s gait

Gait analysis is especially useful when a new treatment plan is being developed or when a major change in treatment is being considered. Testing is determined by the treatment goals for your child, as well as your child’s age, level of functional independence, and ability to participate in structured testing.

"The impact of gait analysis has changed how children with walking difficulties are diagnosed and treated. Gait analysis has allowed us to be much more specific about surgery and the surgery we’re doing has more predictable results."

The Cerebral Palsy Center at Nemours/Alfred I. duPont Hospital for Children offers top-quality pediatric orthotics services right here at the hospital, which include:

fittings and adjustments by certified orthotists (orthotic specialists) to ensure your child’s comfort and stability. In some cases, we can fabricate a custom orthotic or brace for your child on the same day it’s prescribed by our doctors

thorough follow-up care, since children’s rapid growth often means their orthotics will need to be rechecked frequently and may require some modification

Wheelchair Clinic

Our on-site Wheelchair Clinic, part of our Assistive Technology (using technology and devices to help with daily living) program, offers a team approach to the evaluation and recommendation of seating and mobility equipment for children and teens. Our experts will recommend the solution that best fits your child’s needs, to help promote independence and better functioning within the home, school and community environments.

Our team includes:

a rehabilitation engineer

a physical therapist

an occupational therapist

a rehab technician

wheelchair vendors

Working with the Cerebral Palsy Center, we’ll thoroughly evaluate your child’s mobility and positioning needs, collaborating with your orthopedic surgeon, neurologist, rehabilitation medicine physician and pediatrician. We can provide documentation to the vendor and to your insurance company for the authorization of the recommended equipment, and even assist with insurance appeals, if necessary.

The Wheelchair Clinic will precisely fit your child’s wheelchair and seating system upon delivery and can make minor adjustments as needed over time. Additional services include pressure mapping (seeing if there are spots where your child’s seating causes too much pressure), custom molded seating, trying out various power seating systems and alternative drive controls.

Augmentative Communication

Our Augmentative Communication (communication methods used to help or replace speech or writing) team, also part of Assistive Technology, will work alongside the Wheelchair Clinic to integrate communication aids into your child’s seating system.

The Augmentative Communication team is made up of experts from several fields, including:

speech and language pathology

physical therapy

occupational therapy

rehabilitation engineering services (specialists who use the principles of engineering to design or adapt assistive devices)

Teamwork is essential in this process — the team actively seeks to build a strong collaboration among children, parents and family members, community-based therapists and teachers, and the Cerebral Palsy Center staff. The team can help your child use his or her own communication skills in addition to augmentative communication methods for enhanced success in a variety of settings.

Specialized Assessments

We offer complete specialized assessments, as well as individual therapy and training, consultation with your child’s other therapists and educators, and assistance with the set-up and customization of any assistive technology aids.

Although the majority of services are conducted on an outpatient basis at Nemours/Alfred I. duPont Hospital for Children, we also provide on-site services in schools and other facilities when needed. Our goal is to supplement, not replace, your child’s natural speech and writing to the greatest extent possible.

We’ll conduct a complete evaluation of your child's language, reading, spelling and communication skills, along with his or her visual, motor positioning and mobility functions. Evaluations include hands-on trials of various equipment models. Our goal is to determine if assistive technology is required, and if so, which specific products may help to functionally improve your child’s literacy skills and support his or her learning.

Follow-Up Services

After our team makes its recommendations, we may follow up with:

assistance in getting the funding for speech-generating devices (including additional documentation if you need it to appeal any initial denials of coverage from health insurance plans)

outpatient therapy in our clinic, with individualized treatment plans and family education

assistance and instruction with set-up and customization of your child’s assistive device or specialized computer software

consultation and in-service training programs for school and family teams, in which we provide proven techniques for integrating augmentative communication and assistive technology into your child’s curriculum and learning experiences, functional activities and day-to-day family life

Therapy Services

At the Cerebral Palsy Center at Nemours/Alfred I. duPont Hospital for Children, we offer highly specialized therapy services for our cerebral palsy patients. As a sign of the excellence of our therapy services and facilities, we recently earned re-accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) International. Our inpatient and outpatient programs are recognized for their commitment and dedication to improving the quality of lives of our patients and families.

Physical Therapy

Our physical therapy (or “physiotherapy”) programs are designed to encourage your child to build a strength base for improved gait (walking) and movement, together with stretching programs to limit contraction of the muscles. Many cerebral palsy experts believe that lifelong physiotherapy is crucial to maintaining muscle tone and bone structure, as well as preventing joint dislocation.

We’ll work to limit the effects of any physical challenges and help your child reach his or her full potential, maximizing independence, fitness and gross motor functions (those associated with the large muscle groups that often affect the ability to move).

Your Child's Treatment Plan

We also consult with the rest of your child’s care team, including occupational therapists, orthopedists, neurologists and even school personnel to ensure we’re creating a plan that meets your child’s functional needs in every setting.

Pediatric physical therapy may be provided on an inpatient or outpatient basis with:

gait training

postural training

activities for building endurance

muscle strengthening

increasing range of motion and flexibility

enhancing coordination and balance

learning to use a prosthetic (an artificial device that replaces a missing body part)

increasing overall fitness

aquatic therapy

If necessary, we also may recommend certain types of adaptive equipment or customized assistive devices that will help increase your child’s independence at home and school.

Occupational Therapy

Working with the Cerebral Palsy Center, the hospital’s occupational therapists can help your child maximize function, adapt to any limitations and live as independently as possible. We incorporate a family-centered care philosophy, including you and your child in therapy decisions and treatments. After our initial evaluation, our occupational therapists will design a comprehensive occupational therapy program tailored to your child, with a goal of achieving as much function and independence as possible.

Our pediatric occupational therapy treatment plan may include:

muscle training and movement re-education

building endurance

enhancing coordination and balance

fine motor training (such as handwriting)

hand-eye coordination/motor skills training

learning to use a prosthetic (an artificial device that replaces a missing body part)

improving self-care techniques

We routinely fabricate upper-extremity splints for postsurgical (after surgery) patients as well as for patients with neuromuscular disorders and cerebral palsy. If necessary, we may also recommend certain types of adaptive equipment or customized devices that will help your child to feed, bathe, go to the bathroom and perform other activities of daily living independently.

A certified hand therapist is also on staff, which enables us to provide specialized pediatric occupational therapy for children with hand limitations.

Speech & Language Therapy

Our pediatric speech and language therapy specialists can help your child with any general speech and language disorder or delay. They’ll also work with you to help transition your child's newly learned skills into your family’s home for quicker, longer-lasting results.

Speech therapy helps control the muscles of the mouth and jaw, and helps improve communication. Just as cerebral palsy can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years.

Speech therapy can help your child with the actual production of sounds, whereas language therapy helps if your child has difficulty understanding or putting words together to communicate ideas.

Our therapists will help your child develop sign language skills and offer coping strategies. We also offer a pediatric voice program to help children who are physically or cognitively limited in their ability to speak.

Surgery

The Cerebral Palsy Center’s pediatric orthopedic surgeons, as well as Nemours surgeons in other specialties that your child might need, are skilled in surgical procedures that treat complications related to cerebral palsy and other neuromuscular conditions. Whether your child needs routine outpatient surgery or more complex inpatient surgery, you can be assured that you’re receiving the best surgical care available.

Common Procedures

Some common procedures performed for patients with cerebral palsy include:

loosening tight muscles and releasing fixed joints — most often performed on the hips, knees, hamstrings and ankles. In rare cases, this surgery may be used for children with stiffness of their elbows, wrists, hands and fingers.

the insertion of a Baclofen (a muscle relaxant medicine used to counter the effects of spasticity) pump — this is usually placed in the left abdomen and is connected to the spinal cord, to which it sends small amounts of Baclofen to alleviate the continuous muscle flexing.

straightening abnormal twists of the leg bones — this is a secondary complication caused by muscles that spasm and generate abnormal forces on the bones, and often results in a pigeon-toed gait (walk).

surgery on the nerves affecting the limbs most affected by movements and spasms — this procedure reduces spasms and allows more flexibility and control of the affected limbs and joints.

correction of spinal curvatures — this can improve comfort and ease of sitting, and prevent internal organ compression.

surgery to correct joints that have become dislocated or sublimated — this is especially common with the hips and feet.

Other surgical procedures are available to help with other problems, including digestive issues (gastroenterology) and otolaryngology (ear, nose and throat/ENT).